Archive for the ‘COLUMNS IN "REALITY CHECK"’ Category

Twenty-five years ago, I went to trial for alleged malpractice. During the trial, the plaintiff’s lawyer kept quoting a neurology book, trying to make it appear that I practiced below the standard. Each time, I asked to see the passage, and each time, I read the paragraph before and after the lawyer’s quotation. He was quoting out of context. He was lying, to make a point. The third time I asked for the book, he literally threw it at me, on the stand. Several jurors actually gasped. For the first time, I thought I might not lose. I didn’t, but of course in a malpractice trial, a physician never wins: it is lose or not lose.

I question whether the U of A’s new to promote civility will be successful. I will try to be civil in my comments.

I find it difficult to be civil to those who did not serve this country in uniform, but are quick to support our military in our many misadventures that have cost hundreds of thousands of lives and trillions of dollars. I was among the 16% of Americans in 2003 who thought invading Iraq was a bad idea. I was right. I am often right on the big issues, not that it matters much. The bullies and the jerks usually win.

I find it difficult to be civil to bullies who use ideology, rather than facts, to call those who disagree with them unpatriotic, and sold a war that has been so costly. These bullies polarized the country. Worse, the media supported them in the name of “balance.” We allowed the debate on health care to be uncivil, allowing words like “death panels” into the national discourse. My opinion piece was entirely civil, factual, and appropriate, since I have dealt with death and dying many times when my colleagues were quite happy that I, and not they, would.

During the last total lunar eclipse, CNN interviewed two astrologers, no astronomers, because the eclipse happened to occur near the solstice. Is this what America has come to? I will ask: what does a total lunar eclipse require, and why does it occur? Can you tell me why we have seasons? Can you tell me how you would determine the number of square feet in an acre and how many square kilometers equal a square mile? Can you tell me what case follows the word “between”? Do you know where Guadalcanal is, why it was important and what Marine Division has it on their emblem?

I find myself difficult to be civil to those who disparage science, want to take us back several centuries, at the same time enjoying their cell phones, cars, food and water so safe we don’t think about it. I find it difficult to be civil when I am in a minority of Americans who believe global climate disruption is occurring and man caused. And I will not argue this with anybody, unless they (1) avoid all use of pejorative language, (2) use statistical terminology and (3) state the consequences if they should be wrong. I have yet to find anybody who can do this. I find it difficult to disagree so without being disagreeable, for I see these people and others destroying a country that I served as an officer in uniform, and at least 98% of Americans have not.

I find it difficult to be civil, when 10 years ago I proposed a reporting and counting system for medical errors, which failed. And do we know the scope of the problem in 2011, and have we improved our care?

I find it difficult to be civil to those who received complete data on 6th grader obesity–from 5 middle schools–promised to help, and didn’t. Tucson has a grant to deal with this problem, when with a few volunteers from PCMS and the school of nursing, we could have obtained data from every middle school in the county–free, since I would not have charged for my data analysis.

Do we have any data this year? None that I know. The principal at one of those middle schools yelled at me, uncivil, although we were helping him meet his mandate. What is happening in his school? Is the median BMI still at the 89th percentile, rather than the 50th? Are 14% of his students still above the 95th percentile and 7% above the 99th percentile, 3 and 7 times the expected values, respectively? Is his school representative of the county? Does anybody care?

What we need in America are volunteers, service, ideas, hard data, willingness to say “I was wrong,” and polite, respectful discussions with willingness to listen. It is time we say “no more” to those who deliberately lie to push an agenda. It is time that we and the media gasp, like the jurors did in January 1986, call these bullies out on their lies, because equal time requires equal facts. Bullies must be stopped, whether high school students, lawyers or fat old non-veterans who deliberately lie on the public airwaves.

I took my skills out of medicine to other fields. I now wonder whether I take myself and my skills out of this country, which I see as in major decline, because of lack of MY “family values”: education, politeness, population control, caring for the Earth and all its living beings.

How many people do you need in a room before any two are more likely than not to have the same birthday?

Twenty-three.

I’m sure there are those who disbelieve, saying “I know that can’t be right.” What is disturbing is that even when a simple proof is delivered, many continue not to believe it. That is stupid, but these days disbelief of reality by people in power is beginning to destroy this country. The proof looks at the probability that two people don’t have the same birthday. Here are the probabilities:

Number of People

Prob (2 have same Bday)

Probability (2 don’t)

2

0.003

0.997

5

0.027

0.973

10

0.117

0.883

15

0.253

0.747

20

0.411

0.589

22

0.476

0.524

23

0.507

0.493

25

0.569

0.431

30

0.706

0.294

35

0.814

0.196

A disease has a prevalence of 1 in 200 (0.5%), a sensitivity of 98% and specificity of 99%, meaning if you have the disease you test positive 98% of the time and if you don’t you test negative 99% of the time. Not knowing if you have the disease, you test positive. What is the probability you will have the disease? The issue here is that having the disease and testing positive is very different from testing positive and wondering if one has the disease. If the disease is rare, the likelihood of a positive test’s being a false positive is significant. Here’s why, using 10,000 people and the above percentages:

Test Positive

Test Negative

Total

Disease Positive

49

1

50

Disease Negative

99

9851

9950

Total

148

9852

10000

If you test positive (148), a third of the time (49) you will have the disease. The others are false positives. That’s why we don’t do routine HIV blood tests for marriage. In a randomly selected individual, and that is important, a positive test for something rare has a significant likelihood of being a false positive.

Many mountaineers defend the safety of their sport by saying one can get killed in a car accident. We all know someone who died in a motor vehicle accident, but relative to the denominator, it is small, 1 in about 7000 Americans each year. Mountaineering is a small community, and number of climbs is a small denominator. Every serious mountaineer has lost several friends in the mountains. Mountaineering is far more dangerous.

The lottery is a tax on those who don’t understand probability. The chances of winning the Powerball jackpot are approximately those of randomly picking a minute chosen since the Declaration of Independence was signed, 1 to 110 million. Yet people continue to tax themselves because “if you don’t play, you can’t win.”

Too many Americans play “I’m sick do I see a doctor?” lottery: I have abdominal pain, and I don’t have insurance. I hope it goes away. But it doesn’t; instead, the pain worsens. I call an ambulance, go to an ED and am admitted with a ruptured appendix. The costs have increased and are well in five figures. I’m bankrupted by the illness, nobody gets paid, and my productivity is zero for a long time. I’ll probably never get out of debt. If I get sick again, I’ll bet again it goes away. I will have no other choice. I’m betting that my body’s natural healing ability will bail me out. Maybe it will. Or maybe it won’t.

We were once the richest country in the world. Our annual medical costs are far more than a trillion dollars. A trillion is roughly the number of days since the Earth formed. How many these costs could have been avoided by timely prevention? How many could have been avoided by universal coverage? I don’t know. But I do know that our system makes it impossible for at least a sixth of Americans, not Zimbabweans, to get decent, timely care and not be bankrupted by it. If you don’t want my solution, you fix it. Here are my metrics: your fix has to show an increase in productivity, a decrease in emergency department overcrowding, a decrease in bankruptcies that are primarily due to medical reasons and a decrease in late diagnosis of disorders like appendicitis, that should all be picked up early–in America, not Tajikistan.

If that requires I pay more taxes, I’ll pay them. I’d rather pay taxes for education and health care than for fighting, foreign aid to countries who despise us and bailouts to car makers who built monstrous SUVs, when it was obvious decades ago we needed to retool. The selfish say, “I got mine, and the hell with you.” Liberals like me say, “I got mine, and I want to help you get yours.”

I’m a patient, and I’m tired of waiting weeks to see a physician (I thought only Canadians waited), worrying about medical errors that affected me and three family members and really tired of the bickering and the lies that stalled any meaningful reform. It is disgusting and un-American.

The above birthday problem was solved by looking at what we didn’t want to find what we did want. I don’t want a huge national debt. Here are 2 thoughts: end our wars, and enact a 90% marginal tax rate on those with incomes over $3 million.

I was recently auctioned off for a charitable event. No, nobody was buying me, but they bought a dinner with me at a friend’s house with a star party to follow. My job was to show up for the dinner then show the stars afterwards.

For 20 years, I wrote 750 astronomy columns for the local paper. I don’t do much observing any more, other than chasing the next solar eclipse, which I’ve done 20 times, successful on 17. I was once an avid observer of variable stars, sometimes getting up at 2 a.m. to make visual observations on one that the AAVSO (American Association of Variable Star Observers) needed. I was so good, my eyes could detect a 0.1 change in magnitude. I’ve seen about 400 galaxies, 2000 double/multiple stars, all the planets and once followed about 25 variable stars without using star charts.

The night sky is predictable enough to be reassuring but changeable enough to be interesting. In 1999, I saw 300 Leonids meteors in an hour. I saw a red glow over the Catalinas in ’89, realized there was no fire but in fact an aurora. I’ve seen one grazing occultation, where the Moon’s limb was tangent to a star, so that the star blinked in and out of view as the valleys and mountains of the lunar edge passed by. That was really cool. For many years, I did photoelectric photometry, then having to reduce the data by hand. Other than a total solar eclipse or a total lunar eclipse, the occultation of 28 Sgr by Saturn in 1989 might have been the most striking thing I ever saw. As Saturn covered the star, I could define every ring layer by the star’s passage. I still have my notes for that one; the star disappeared from view 38 times in 45 minutes! That was beyond cool. I stayed out half the night looking, and I had an office full of patients to see the next day. I’m sure more than a few of those patients noted the doctor was tired, but finally seeing the star in between the globe of Saturn and the inner ring was an image I will never forget.

I wrote an article for Sky and Telescope several years ago how astronomy and dark skies freed me from my shyness. After I was auctioned, I didn’t know what would happen; the person who “bought me” was a minister, and I had some trepidation about the evening. After all, some ministers believe the Earth is 4000 years old and don’t realize that we are made of star stuff; our Sun is at least a second generation star. I am not religious, but I am intensely spiritual, the idea of the elements coming from stars strikes me to my core. The iron in my hemoglobin, the calcium in my bones, and the carbon in the fat surrounding the myelin sheaths in the corticospinal tract leading from my brain to my lower spinal cord are just a few examples.

I wore my Argentinian eclipse T-shirt that two delightful women, brilliant German astrophysicists, gave me after the event. I arrived at John’s house early, set up my ‘scope (20 cm reflector), then had a beer with John and his wife. John and I go back a decade as bike riders. I quit the sport in 2006 after breaking my 6th, 7th, 8th and 9th bones, but we stay in touch. Just as I finished my drink, the other guests arrived.

We went outside, as the brightest stars appeared. This is navigational twilight, when the Sun is 6-12 degrees below the horizon, light enough to see both bright stars and the horizon. I pointed out the Summer Triangle and Jupiter, and described star magic. In Tucson, the mountains allow a rising star to suddenly pop into view, so if one can determine the exact time of its rising, she can go out 4 minutes earlier the next night and count down 4, 3, 2, 1 RISE! And the star will rise. It is like magic, except of course, it is entirely predictable. I also spoke of “Earthmove” rather than “Moonrise,” for I have learned that if one changes perspective, it is possible to see the Earth rotate, which in fact is what Moonrise is. I do it many times a year. Seeing the Earth rotate is primal.

The minister thought all this fascinating. His wife sat next to me at dinner and is, like me, is a teacher. Before we finished dinner, she had invited me to her advanced junior high math class next February to talk to them about math in the outdoors, a subject I am particularly interested in. American kids need to get out more, and this is one way.

After dinner, we went outside, and looked above us. Even in the suburbs of Tucson, we can see the Milky Way. I pointed out the beautiful curve of Andromeda, found the Galaxy, showed the star clusters around Mirfak in Perseus, the Pleiades and the Hyades. I taught them how to use their fist to show that the elevation of Polaris was our latitude, and that Kochab, in Ursa Minor, is Arabic for “Pole Star.” which it was 3000 years ago.

As we turned to look at the southern sky, a minus 8 magnitude fireball, a meteor, shot across right in front of us. Everybody saw it. I’m not one into “signs”, but I had to be a bit impressed that we happened to turn at just the right time. The minister and his wife were fascinated by the Moon. I pointed out Alpenglow, where the tops of the mountains were lit up away from the terminator. His wife loved seeing that. I spoke of nuclear fusion in the center of stars, walking over to the sand nearby, pointing out that the silicon was made inside a star. Heady stuff. I showed them Albireo, a gorgeous blue and gold double star at the end of the Northern Cross, which seemed appropriate for a group of Christians.

I spoke so much that once again I forgot that I was a shy person. I was bubbling over with knowledge about the sky. I consider myself a profound introvert. But it is all relative, for once I get talking about astronomy under a dark sky, a solar eclipse, the wilderness I have seen, or the Sandhill Crane migration in March, I’m a different person. For a long time, I thought it was the wilderness and the night sky that changed me. But it’s more than that. The next day I thoroughly enjoyed myself as a substitute math teacher. What brings me out of my shell is teaching. I am a natural teacher. The minister and his wife learned a great deal about the sky that night, but I was luckier; I learned something about myself I had never realized before. When I teach, I am a completely different person. And I like that person a great deal.

In November, I went to the Bosque del Apache National Wildlife Refuge for the Festival of the Cranes. I got to see fellow volunteer crane guides and took a course in Sandhill Crane behavior, with on site examples. I also visited the VLA, the Very Large Array of 27 large parabolic radio telescope dishes on movable tracks.

Lesser Sandhill Cranes are remarkable birds, some migrating as far as Siberia. I now can identify juveniles, males and females by voice. I can identify their unison calls, see the aggressive behavior they may display afterwards, and describe their dancing. I was a decent guide last spring; I will be a far better one next year.

I stayed at a house in Socorro while the owners were temporarily living at the Refuge, volunteering. Erv and Sandra are a remarkable couple; both well into their 60s, they are “professional volunteers,” known in the Fish and Wildlife Service as a couple who will go to a place for a few months, make a big impact, then move to another area. In 2008, when I first met them, they “followed” the Sandhill Cranes north from their wintering spot in New Mexico, to the magnificent staging of 600,000 on the Platte, to Homer, Alaska, finally ending in Fairbanks. While I was in New Mexico, they received an offer to go to Coldfoot, Alaska next summer. They are either going there or to the Columbia River. They are in demand. Sandra can do it because she has two artificial joints. Bravo for science, bravo for Medicare, bravo for Social Security.

My first evening, I went with both to watch the evening fly in of the cranes to a wetland. Unfortunately, there weren’t many when I was there. The cranes migrate south later every year, because the Arctic has warmed so much. Indeed, the dates of the Festival will likely have to change. One can argue about climate change, but cranes don’t argue; they sense warmth, not politics; 65% of bird species in the Christmas bird count, which I help out in, have moved significantly further north. Erv and Sandra introduced me to several of their friends in a nearby RV park, and I was invited for dinner. I was going to drive back to Socorro, grab a sandwich and sleep. Fortunately, I didn’t.

That evening, I spent time with 6 other couples, all of whom older than I. The food was good, the conversation better. They were fascinated with my eclipse chasing and experiences. Politics stayed out of the discussion, and mostly medical issues, too, a rarity among the elderly. These people had worked for decades and were enjoying their retirement. I wonder if they would be if it were not for the science so many disparage or the liberal programs of Social Security or Medicare. I just wondered, but I kept my mouth shut.

I did open it later, however, to speak to the man who owned the RV and had been quiet most of the evening. Quiet people often have a lot to say, if one can draw them out. This man was no exception. He was a physicist who worked at JPL and was surprised that I knew of it. Are we so “educationally challenged” these days that we don’t know of the JPL, the place that allowed Americans get to the moon and do all sorts of other wonderful things?

The man was a pioneer in fiber optics. He told me about silica (SiO2), the stretching and strength properties of the pure substance, which is the best spring we know of. He told me that he thought it was better than satellite transmission, since it was faster and had fewer delays, so long as it was protected. Satellites, as we all know, are far from safe, given solar radiation and space junk. Bouncing signals off satellites leads to longer delays. They are also more difficult to repair. Fiber optics have revolutionized society, including medicine, although I learned fiber optics were most helpful was in transatlantic cables.

This man disparaged himself by saying that he was out of date. But his explanation of fiber optics was by far the best I had ever heard. Perhaps that is because he mentioned one of his teachers in quantum mechanics: Richard Feynman, arguably the most brilliant physicist in the 20th century, and who single handedly figured out what happened to Challenger using simple science that even most Americans could understand.

I’ve come full circle. In July, I met a young physicist from Germany, a woman who is working on an X-Ray telescope that will allow us to learn a great deal about X-Ray radiation sources in the universe. She represents where we are going–brilliant, part of a large team, well educated, well traveled and articulate.

In November, I met an 80 year-old retired physicist who worked on fiber optic cables and studied under Feynman. He represents the past and helped me understand how we got to where we are today. Twice now, I’ve gone to see something and discovered far more. In July, I went to see an eclipse; in November the Sandhill Cranes. But my memories of both will be of two different people I met on each trip, young and old, German and American, woman and man, same field, different eras. Both had a great deal to teach me. All I had to do was draw them out. For some reason I really don’t know, I did and was better for it.

I recently took my 58th canoe trip into the Boundary Waters, having spent more than 1 month of my life camped on one lake and more than 1 year camped in the lovely country on both sides of the international border. I’ve paddled on more than 300 different lakes, traveled 3000 miles, cleaned 500 campsites, and even dug 16 latrines in the 30 years I’ve been going there. I’ve done half as much traveling in Ontario’s Algonquin Park back in the spring and early summer of my life. I started 50 years ago and feel more comfortable in a canoe than in a car. Safer, too.

I don’t travel hard any more. I used to love to do so, glorying in 20 mile days with 15 portages, carrying a pack under a canoe for up to a mile at regular walking pace through the woods. Oh, I was good in the summer of my life. I could reach shore, unload and be portaging in under a minute. When I reached the other side, I would be loaded and on the water in 30 seconds. I could make camp at night in 30 minutes, break it the following morning in 45. Now, however, I am happy to base camp with my wife and do short day trips around a lake we can truly say we know better than anybody else alive. We have been on every one of the 47 campsites (the maps were in error and the Forest Service didn’t know that), and we now spend 5 nights a year on one campsite so remote that we don’t see any other human being during that time.

While I am not as strong as I once was, I am much more savvy in the wilderness. I don’t waste effort on portages. I am a superb weatherman in the wilderness, predicting storm onset and ending accurately with nothing more than a barometer on my wrist, reading the sky, and knowing the wind. I thoroughly enjoy doing that.

Oh, I could do more if I HAD to. Maybe. But I don’t want to any more. It’s been 9 years since I carried a pack and a canoe together. I have nothing to prove and a lot I could hurt. As I have gotten older, my desires have changed. Do I miss the strength I once had, propelling me miles and miles to the next campsite? A bit. Do I need to do it again? No. For some reason, I revel in the fact that I once could do it but comfortable I don’t need to any more. I know now that I probably took my last trip into Kawnipi Lake in 2005. At the time I thought it would be. Then I figured…maybe one more time. Now, I’m not so sure I either need to, or more importantly, want to. I still want to see the northern sweep of Agnes Lake again, and a fellow teacher, who desperately wants to go, may be my partner on that trip. The two of us could do it. Gee, maybe Kawnipi, too, but nature may have other plans.

I have nothing to prove in the canoe country, although occasionally I still enjoy doing so. My wife and I paddled 12 miles into our destination lake in 6 hours, with 7 carries, when several people we met, 20 years younger, were unable to get there in 3 days of work. Neither of us is strong, but our experience, organization and leveraging of our skills, working together, enables us to still accomplish a good day’s work in a few hours. Neither of us thought it was a difficult day.

Do I miss “roughing it”? Not really. I once liked sleeping under the canoe and paddling in a driving rain, but I don’t need to do it any more. The way we camp is comfortable. We eat well, stay clean and dry, and sleep better than we do at home. The midnight bathroom breaks are a chance to look at one of the darkest skies in America and perhaps see an aurora, which we did a few years ago.

I find it interesting that as I have gotten older, my needs have changed, and I get pleasure doing different sorts of trips I once wouldn’t have enjoyed. The trips I used to do no longer appeal to me. I am at peace with that. I expect more changes, and hope I still can paddle and portage for many years to come. But I expect I will be doing so in a different fashion, and I believe that I will be enjoying it just as much.

We were in the canoe country in autumn, present when the colors peaked. In the autumn of my life, the colors are starting to peak. I don’t have the strength and growth I had in the spring and summer of my life, but I have found my own inner beauty that mirrors the external beauty around me. I still see new country, but I enjoy visiting familiar country the way some like meeting new people but enjoy old friends.

I tell myself I won’t be able to do this forever, but I am glad for the now. I hope in ten years, in my seventies, I will be still be able to canoe and set up camp. The gear is getting better, and my knees and shoulders are strong. Whether my neck holds up is another matter, but I bet I could figure out a way to get a canoe on my head without stressing my neck, should that come to pass. If not, I can paddle lakes where I don’t portage, because there are many of them, too. In short, my body is like a well-used Old Town. It won’t last forever, and it is showing use. The paint is scraped, there are a few cracked ribs, but it is still sound and seaworthy.

I hope that as the winter of my life approaches, the white in my hair will mirror the brilliance of new fallen snow, untouched, in those areas of Alaska’s Brooks Range that I have been so fortunate to have explored four different times. Could I canoe into my eighties or even nineties? I can dream, for this year two very special people, different sex, different countries, different professions, and different beliefs had a profound influence upon me. From each, and quite by accident, I learned that while I am a scientist and statistician, consider myself a practical person, not far below the surface lies a kid–a deeply emotional, spiritual dreamer. I’m not planning to mentally ever grow up. When I arrived in Fairbanks, many my age or younger went to the Princess Cruises sign. I picked up my backpack. In Minneapolis, I feel a bit unusual at 61, walking through the airport with my canoe pack on. The white I want to see is not a golf ball but an eagle’s head. With luck, I have just started autumn. May it continue to be as brilliant inside as it was along the Fernberg east of Ely, Minnesota. May the winter that follows it be as brilliant as the snow that made Mt. Igikpak so beautiful over the Noatak last August, up in Gates of the Arctic.

Eventually, of course, my eyes will finally close forever. I hope at the end I feel the same as Sig Olson, the famous North Country writer, who still had written, in his typewriter, the day he died, snowshoeing, “I am ready for the next stage. I know it will be a great adventure.”

On an early March afternoon this past year, I was on my hands and knees building a large sundial at Rowe Sanctuary in central Nebraska, where people stand on the date and their shadow tells the time. From the second week in March through the second week in April, Rowe is busy as visitors arrive from all states and a few dozen countries to witness the Lesser Sandhill Crane migration, one of the three greatest natural sights I’ve seen and one of Jane Goodall’s top ten. I was working pre-season and decided a nature center like Rowe needed a sundial.

I was using markers, T-squares, a calculator and duct tape when a good looking young man stopped by. He was friendly, and I knew him as the Great Plains photographer Michael Forsberg. Mike was interested in what I was doing with trigonometry and ellipses and then asked if I could find him information for the full Moon azimuth as it rose. He wanted to know exactly where in the eastern sky he would see it rise.

Fulfilling a request from Mike Forsberg suddenly became my top priority, so that evening I sent him the information. He later e-mailed me pictures he had taken out in the viewing blinds, including an incredible shot of 4 different species of geese flying together. Imagine, the premier wildlife photographer in the American midwest e-mailing me pictures he took! Later that week, when I saw Mike again, I had him sign one of his books for me. I just happened to be making a sundial when he walked by. He just happened to stop. And that changed my life. I just didn’t know it at the time.

When I left Nebraska in early March, I felt I had unfinished business. I had not been there when the migration was in full swing, nor had I led tours to the viewing blinds, which had been a goal–a dream–of mine. Four weeks later, I flew back to Nebraska, to volunteer at the height of the crane season, when 600,000 birds are on a short stretch of the Platte River, flying in at night to the safety of the braided channels and flying out to the fields in the morning to eat waste corn. That week, I worked 17 hour days, sleeping on the floor in the visitor center, because local housing was full, listening to the cranes call on the nearby Platte. The first night I shared a floor with– Mike Forsberg– who now knew me. We didn’t talk much but I soon learned Mike is modest as he is good. He deeply respects Rowe volunteers, because we help make some of his photography possible. His nature photography is the best I’ve ever seen.

I finished my training and became a lead guide, meaning I could take visitors to the viewing blinds. I got to talk about Lesser Sandhill Cranes; I watched people smile and heard them cry when they saw the cranes land, “dance,” and call before them. Sandhills are large and loud, their voice primitive and deeply primal, echoing across 3 million years of time. My enthusiasm outweighed my shyness, and I thoroughly enjoyed guiding. We volunteers were a cohesive group, all of us working together to do whatever needed to be done, even if it wasn’t our “job.” That week, I felt alive in a way I seldom have experienced. So often, I told visitors, “I work 17 hour days, make coffee at 5 a.m., clean toilets, sweep the walk, give “Crane 101 talks,” do odd jobs, get dinner, sleep on the floor and see the cranes morning and night. Am I lucky or what?” When I called home, my wife commented my voice sounded different.

Mike stayed in the visitor center a second night: two Mikes, two nights, too cool, two of his books I bought. Mike signed the second one, too, adding a stunning phrase, calling me “a man of great spirit,” for he had quickly recognized something in me that I had not fully appreciated: I have a deep spiritual connection to nature, the outdoors and wilderness. Mike is a man of faith and told me he felt closest to God when he was in the photography blinds, where people are taken in late afternoon and cannot leave for any reason until mid-morning the following day. He said the experience was beyond comparison. I’m going to do it next spring. It has become one of my dreams, and while I, a scientist and a statistician, consider myself a practical person, not far below the surface lies a deeply spiritual, emotional dreamer. Somehow, Mike knew that and how to help me understand myself better.

Last July, after the eclipse in El Calafate, Argentina, I sent Mike a picture. I was a bit embarrassed to be sending a handheld shot to a famous photographer. Mike, however, immediately replied “very, very cool,” saying I must be the only guy in the world who was going to Patagonia in July and to northern Alaska in August. I wrote him after I returned from the Brooks Range, 118 degrees north of where I was in South America, telling him I would be ordering one of his pictures as a gift. I am becoming friends with a special man, because we share a spiritual bond with the outdoors, especially Sandhill Cranes. If he hadn’t stopped when I was making the sundial, this never would have happened, and my perception of myself and indeed my life wouldn’t have changed.

* * *

July 9 is a holiday in Argentina, independence day. I was in Buenos Aires, appropriately staying on Avenida 9 Julio, the largest street in the world. That day reminded me of Christmas, for it was a winter holiday at a similar latitude south of the equator as I live north.

I went to a restaurant as part of a tour, going up a narrow set of stairs to a table with other people on the tour. One of the guides asked me to sit in the middle of the table next to a young German woman. And that changed my life and hers, especially hers.She and I will never be quite the same again.

The woman, Maria, was a young German scientist on her first trip out of Europe. She, like me, was in Argentina for the solar eclipse. Both of us had expected to take a plane to fly over the clouds to see the eclipse, but the flight had been cancelled. My trip down to Buenos Aires involved barely making a connection; had I missed it, I might have gone home, since the probability of seeing an eclipse in Patagonia in winter is poor. What kept me going was the idea if I didn’t go, and people saw the eclipse from the ground, I would never forgive myself. I didn’t know at the time the details of Maria’s trip, but it seemed clear we would be “clouded out.” I later learned she had been at a conference in California, had a car accident on a freeway, and brought no winter clothes with her, since she was also planning to see the eclipse from the air. To say we were both depressed and having an awful trip was an understatement.

Maria was completely fluent in English. I asked her what she did, learning of her work in preparing an X-Ray satellite for launch to the LaGrangian point furthest from the Sun. Fortunately, I knew something about LaGrangian points, where the Earth and Sun’s gravitational pulls are equal, leading to stable orbits for bodies located there. Because I had studied physics, I was able to ask intelligent questions, soon learning about the LaGrangian point 1.5 million km beyond the Earth where the satellite was going. Because I knew about conics, the concept of parabolic and hyperbolic mirrors was understandable, and the major and minor axis of the elliptical orbit clear to me. I listened to Maria for a good 30 minutes. When she asked me what I did, there wasn’t much to say except I chased eclipses, taught math as a substitute, once practiced neurology, liked cats and was a vegetarian. She taught math, liked cats and was also a vegetarian. Naturally, she was most interested about my eclipse experiences.

On the afternoon tour of the city, we spent some time together, Maria convinced she wouldn’t see the eclipse. This being my 20th eclipse trip, I told her many times: “Maria, it isn’t over until it is over and we didn’t see it.” Indeed, a year earlier, in China, a small window opened up through thick clouds right at totality. We went absolutely nuts. It was the only eclipse I ever saw while I held an umbrella.

I didn’t see Maria again until the next afternoon in Patagonia, when she was an invited speaker at an eclipse conference. I asked a question, later going up and telling her she gave a good talk. She looked like she needed to hear that. That night, at the hotel, I invited myself to Maria’s table of 4, since I was otherwise going to eat alone. I was the de facto trip weatherman; I was following several South American weather models, knew the barometer was rising, the streaming moisture into the “cone” of the continent was cutting off, and high pressure was building over the eastern South Pacific. Maria wanted to know my forecast; I was cautiously more optimistic, telling her to ask me about the barometric pressure the next morning.

That night, the barometer rocketed upward, the sky cleared, and we awoke to a beautiful sight: the southern hemisphere stars were visible. Maria had never seen the southern sky before. I didn’t sit on the bus with her but with Anita, a senior colleague. When Anita pointed out the Southern Cross on the bus ride to Perito Moreno glacier, I did something quite uncharacteristic for me: I went to the front of the bus and asked how many wanted to see the Magellanic Clouds under a dark sky. A lot of sleepy faces raised hands. Nobody objected. We stopped for 5 minutes so everybody, including Maria, could view our companion galaxies.

That afternoon, I worried about clouds interfering with the eclipse, but Anita fortunately kept Maria far from me. When totality was imminent, Maria and Anita joined me, and Maria cried as the Moon completely covered the Sun. I shouted, as did others, and I stared in awe of the shadow cone of the Moon, which I had never seen so clearly. But my greatest memory is hearing Maria cry. It was one of the most moving experiences of my life, and I’ve seen totality 12 times.

The next morning, I said goodby to Maria, and I haven’t seen her since.

But unlike every other eclipse trip I’ve been on, we’ve corresponded. First it was by Facebook then e-mail and frequent Skype chats. That has never happened before. Maria told me that she almost had a panic attack in the restaurant, and my listening to her calmed her down. Just my listening. She got so excited from the eclipse that she has cast off shackles that led her from living a full life. My wife and I invited both Maria and Anita to the May 2012 annular eclipse in northern Arizona, so they can see the Grand Canyon and the eclipse. Maria will cry at both. I know she will. Recently, she went skydiving for the first time. She is learning C++ programming so she can become indispensable on the Australia eclipse in 2012 and get a free trip there. Maria has been the best correspondent I’ve encountered in my life and we’ve become good friends. Because of her, I’m learning German, and I plan to visit her next year. Maybe every year. And that has changed my life.

Had we not had such bad starts to our trips…Had we not been seated next to each other in Buenos Aires…Had I not known something about LaGrangian points and infrared radiation…Had I not been an amateur meteorologist and in demand…Had I not stopped the bus so people could see the Magellanic Clouds…Had we not seen the eclipse, none of this would have happened. Maria would still be wanting to see her first eclipse, and I would not be learning the four German cases. In August, when I returned from northern Alaska, I had a four hour layover from 10 p.m. to 2 a.m. in Anchorage. Had I not met Maria, I would have been bored, tired and cranky. Instead, I chatted with her on Skype, passing the time quickly.

The older I get, the more unpredictable my life has become. If I hadn’t been making a sundial, if Mike Forsberg hadn’t stopped by, if I hadn’t been seated where I was, and if I hadn’t known about LaGrangian points....

When I saw a familiar ship steam into Subic Bay and moor, I decided I ought to visit to check out their sick bay. It would be the only time in our 8 month WESTPAC deployment my ship and theirs would simultaneously be in the same port.

It was a wise decision.

The other ship had a corpsman, and it had been one of my ancillary duties to ensure their medical readiness for deployment to the Western Pacific. Before boarding, I had received a list of their deficiencies: instruments still wrapped in cosmoline, poor record keeping and outdated supplies were the worst. On my first visit, I additionally discovered their Executive Officer (XO) was a Type I diabetic, who apparently varied his insulin depending upon how he felt (this was before blood glucose monitoring). The ship was a floating medical mess, and I told my shore-based medical boss my concerns about the XO. He ordered me to ignore the diabetic and do whatever else it took to get them ready.

My adoptee vessel would spend time training at sea when my own was in port, giving me opportunity to ride her and fix deficiencies. So, the following week, I boarded for three days of steaming 50-100 miles off southern California. After morning sick call, where the corpsman was thrilled to have me, we got to work cleaning instruments, removing outdated supplies, ordering new ones, re-organizing the department. We had a lot to do; unfortunately, their ship rode a lot worse at sea than mine.

Later that morning, I took a break to the bridge wing, watching California recede, when the Captain came up beside me. I saluted, he returned it, promptly ripping me a new one: “I don’t appreciate your trying to torpedo the career of my XO.”

Stunned, I replied, “Captain, what are you talking about?”

“Your concerns about his diabetes went to the Commodore, and I had to answer to him. My XO sees a full Captain at Balboa (the Naval Regional Medical Center), who knows far more about diabetes than you do. So stay out of this, doctor.”

He walked away, not returning my salute.

The Captain at Balboa did know more about diabetes; I was 3 months out of internship. But I was a shipboard doctor, and he almost certainly never was. We had shore based physicians who sent sailors back to the ship with instructions not to climb, when we dealt with ladders dozens of times a day. Another said a sailor couldn’t return to a ship because of exposure to salt spray, as if we were a catamaran, not a 14,000 ton vessel where I stayed drier on a Pacific crossing than a 5 year-old at the beach.

I felt relaxed that December day in the Philippines when I went to the other ship. I had made their medical department ready for deployment. I taught the corpsman everything I knew about diabetes and on a routine physical of a crewman discovered an abdominal mass that was lymphoma.

I asked permission to come aboard, saluting the colors and Officer of the Deck (OOD), saying I could find my way to sick bay. As I walked down the passageway on the 1 deck, the corpsman practically ran me down. “Quick,” he said, “The XO.”

Surprise, surprise.

We rocketed up 3 ladders topside to the XO’s stateroom, where I found him sweaty, uncoordinated with slurred speech, a vial of insulin and a glass of orange juice on his desk. Fortunately, I had ensured the emergency kit had an amp of D50, 50% sugar. I told the XO to lie down, found a vein, and injected. Within seconds, he was normal.

We had the OOD call the local Naval Hospital and the Chief Staff Officer, (CSO), the squadron’s troubleshooter. The CSO was superb; he and I took the XO to the hospital for admission, his sea career finished after 14 years. He would never command a ship. Worse, the ship needed a new XO immediately, difficult in mid-deployment.

I had been proven right but felt like hell. I wish I had been wrong, the XO having no further problems, eventually wearing the 5 pointed star in a circle signifying command at sea. But I knew he never should have been aboard. I occasionally wonder why I went over to their ship that day. Like the lady and the tiger, I wondered had I not been there whether he would have taken/given insulin or orange juice. Not surprisingly, I never heard from the Captain; the CSO, however, thanked me profusely.

We all like being right, dreaming about revenge upon our detractors. I was right, not because of brilliance, but because common sense, my medical training and probability dictated a brittle diabetic had no business being second in command of a deployed warship. I’ve been right on many other issues for decades: climate change, too many carotid endarterctomies, diagnosing depression in patients who thought I was saying they were crazy, chronic pain being highly correlated with not at fault injury, the need for a medical error reporting system. I wasn’t brilliant; all I did was to observe nature and people, be realistic, use science, probability and tried to avoid magical, irrational, ideological behavior I and all of us are prone to. I often wish my conclusions were different or I was wrong, but I try to follow the facts.

Whenever I want to say “I told you so!” I remember that time in Subic Bay. Being right often brings no joy; it only means that one’s observations and conclusions are correct.

How many people do you need in a room before any two are more likely than not to have the same birthday?

Twenty-three.

I’m sure there are those who disbelieve, saying “I know that can’t be right.” What is disturbing is that even when a simple proof is delivered, many continue not to believe it. Our minds can play tricks on us. That’s normal. But in the face of a compelling proof, failure to accept the premise borders on stupid. The proof, by the way, looks at the probability that two people don’t have the same birthday. Sometimes, looking at what you don’t want makes it easier to find what you do want. Here’s the proof:

Number of People Probability 2 have same birthday Probability 2 don’t

1 0.000 1.000

2 0.003 0.997

3 0.008 0.992

5 0.027 0.973

10 0.117 0.883

15 0.253 0.747

20 0.411 0.589

21 0.444 0.556

22 0.476 0.524

23 0.507 0.493

25 0.569 0.431

30 0.706 0.294

35 0.814 0.186

A disease has a prevalence of 1 in 200 (0.5%), a sensitivity and specificity each of 99%, meaning if you have the disease you test positive 98% of the time and if you don’t you test negative 99% of the time. Not knowing if you have the disease, you test positive. What is the probability you will have the disease? The issue here is that having the disease and testing positive is very different from testing positive and wondering if one has the disease. If the disease is rare, the likelihood of a positive test’s being a false positive is significant. Here’s why, using 10,000 people and the above percentates:

Test +

Test –

Total

Disease Positive

49

1

50

Disease Negative

99

9851

9950

Total

148

9852

10000

If you test positive (148), a third of the time (49) you will have the disease. The others are false positives. That’s why we don’t do routine HIV blood tests for marriage. In a randomly selected individual, and that is important, a positive test for something rare has a significant likelihood of being a false positive.

Many mountaineers defend the safety of their sport by saying one can get killed in a car accident. That’s true. But nearly all of us drive and a lot. We all know someone who died in a motor vehicle accident, but relative to the denominator, it is small, 1 in about 5000 to 6000 Americans this year. Mountaineering is a small community, and number of climbs is an incredibly small fraction of number of auto trips. Every serious mountaineer has lost several friends to the mountains. Mountaineering is much more dangerous. I love reading about it, and I admire those who do it, but it is high risk.

The lottery is a tax on those who don’t understand probability. The chances of winning the Powerball jackpot are approximately those of randomly picking a minute chosen since the Declaration of Independence was signed, 1 to 110 million. Yet people continue to tax themselves because “if you don’t play, you can’t win.” You have far more likelihood of being struck by lightning or dying in a motor vehicle accident than you do winning the lottery.

Too many Americans play another lottery, the I’m sick do I see a doctor? lottery: I have abdominal pain, and I don’t have insurance. I can’t afford to see a doctor, so I will bet it goes away. But it doesn’t; instead, the pain worsens, and I now can’t walk. I have to call an ambulance, go to an emergency department and am admitted with a ruptured appendix. The costs have increased and are well in five figures. I’m bankrupted by the illness, few who are involved in the care get paid, and my productivity is zero for a long time. I’ll probably never get out of debt. If I get sick again, I’ll bet again it goes away. I will have no other choice.

Well, you say, that is just a bad example. Here’s another: I have abdominal pain and go to urgent care, because I don’t have a family doctor or it takes weeks to get in. The workup costs $2000. I can’t pay it except in $20 increments. That was my Literacy Volunteer student’s experience. How many Americans say some morning “I have a toothache, I can’t afford to take off work.” They are miserable, and their productivity isn’t very good. Maybe it will go away, or maybe they will need a root canal, which hurts like hell, because there is already a problem. That’s about $1200, so they are more in debt. Sure, they say. if I had the money for dental care, I might have been able to avoid this. Instead, I’m betting that my body’s natural healing ability will bail me out. Maybe it will. Or maybe it won’t.

We were once the richest country in the world. Our annual medical costs are far more than a trillion dollars. A trillion, by the way, is roughly the number of days since the Earth formed. How many these costs could have been avoided by timely prevention? How many could have been avoided by universal coverage? I don’t know. But I do know that our poor system makes it impossible for at least a sixth of Americans to get decent, timely care and not get bankrupted by it. This is America, not Zimbabwe, India or Tajikistan. If you don’t like my solution, you fix it. And not by going back to the 20th or 19th century, since going backwards never works. Here are my metrics: your fix has to show an increase in productivity, a decrease in emergency department overcrowding, a decrease in bankruptcies that are primarily due to medical reasons and a decrease in late diagnosis of disorders like appendicitis, that should all be picked up early–in America, again, not Tajikistan.

If that requires I pay more taxes, I’ll pay them. I’d rather pay taxes for education and health care than for fighting, and not building schools in Iraq and Afghanistan, which is the fundamental solution to terrorism, not nuking Muslims and letting Allah sort it out. We stop foreign aid to countries who despise us and bailouts to car makers who built monstrous SUVs, when it was obvious decades ago we needed to retool.

Do I like government as a single payer? No. But again, if you disagree, you fix it. I don’t want reading assignments. I’m a patient, and I’m tired of waiting weeks to see a physician (I thought only Canadians waited), worrying about medical errors that have affected me and three family members and really tired of the bickering that has stalled any kind of reform. It is disgusting – and is un-American.

The America I served used to have innovative solutions to tough problems. Where is that country?

In early March, a young woman was thrown from her dressage horse during a routine schooling ride. She was rendered comatose and two months later in a rehab facility with a mild hemiparesis but finally able to swallow.

The woman was a member of the US Equestrian Olympic Team, one of only two sports where men and women compete equally. I say “was,” because we both know it is unlikely that she will ever be able to compete again at a high level in dressage, one of the most demanding partnerships between man and animal. She has recovered remarkably well and hopes to teach riding; unfortunately, even her young age was not young enough for better recovery. She is at higher risk for epilepsy, personality and emotional residuals as well. In short, she suffered a catastrophe. Fortunately, she didn’t end up vegetative, especially since the accident occurred in Florida, where adults with 600 gram brains are felt by cardiac surgeons to be conscious and doing well, because they smile even if they can’t comprehend 15 years after the insult.

Florida and the 109th Congress aside, what is finally occurring is a helmet debate in the equestrian community, similar to the helmet debate seven years ago in the cycling community, where 9 years earlier, almost to the day, Andrei Kivilev, a superb Kazakh rider, collided with two other riders on the Paris-Nice race. The other two were fine; Kivilev, 29, hit his head and died the next day, leaving behind his widow and six month old daughter. His death was a catalyst for mandatory helmets in major cycling races, which first did not mandate helmets for mountain top finishes, but now do. Every cyclist in every major event wears a helmet. Something good came out of Kivilev’s death; hopefully the equestrian community will do the same. Already, several equestrian riders have stated publicly that they were saved by a helmet they began wearing.

But there is still no mandate. Dressage riders must dress formally; indeed, proper riding attire is considered appropriate dress anywhere, something I often kid my wife about. Helmets are not part of dressage riding. Well, the judges need to get over it and deduct points should someone not be wearing a helmet. Better yet, it should be cause for immediate disqualification if any rider on a horse at any time at a horse event is not wearing a helmet.

In 1976, Arizona allowed motorcyclists not to wear helmets. I remember the demonstrations at the Capitol. I wonder how many have since died or been permanently maimed as a result of not wearing a helmet. It is time for a helmet debate in this country. At what point do an individual’s rights conflict with the rights of his loved ones to have him (usually a him) around and whole, and society’s rights to pay for the extra care that going without a helmet and having an accident causes? It’s a fair debate. I know where I am on this issue. I, like many of my former colleagues, bitterly remember coming into an ED at 2 a.m. to take care of another drunken biker who wasn’t wearing a helmet. In my case, the lack of payment was a minor annoyance. The sleep I lost was not so minor. We live in a republic. We have a government, and by definition, that government has some control over us, even in the hinterlands of Alaska. We need an honest, factual debate on regulation, without Rush, Bill, Glenn, Sarah, Keith, Jon, Rachel or Steven. In my view, failure to regulate almost took down the world’s economy and has given us wireless service that is worse than many third world countries. There is an imperfect but better middle ground out there that we need to find; otherwise, Zappa’s Law about universality has a third part: hypocrisy, in addition to hydrogen and stupidity.

Growing up, I didn’t know about seat belts; today, even in Arizona, 75% wear them. I skied for 40 years without wearing a helmet; I didn’t know better. Or didn’t want to know better. I knew that ½mv2 =mgh, and a fall at 25 mph was like falling off the roof. I would wear a helmet today if I skied. In my three major bicycling accidents, my helmet was significantly damaged, damage my skull didn’t have. I was not knocked out, even when I could hear the back of the helmet go WHACK! on Moore Road, the day I broke my clavicle.

Physicians need to frame the helmet issue and lead the debate. And after we deal with helmets, we will have to deal with a hot, extremely difficult issue: the long term side effects of playing football as the game is currently played, for the data show that the sport is far more dangerous than anybody ever realized.

For now, the equestrian community must recognize the dangers of being 10 feet off the ground on an unpredictable animal, and where a head might hit if the animal bucks. It won’t be the only buck in the equation.

We will never drive trauma centers out of existence, but every physician should want to. I hope most trauma physicians would be among the first to agree.

I never knew Jamalee Fenimore or Stephne Staples. Nobody who reads this knew them, either. Both of them loved the Sandhill Cranes, as do I. Both have a viewing blind named for them at Rowe Sanctuary in Gibbon, Nebraska, at the southern bend of the Platte River.

Every spring, the Sandhill cranes and the Whooping cranes, the most and least common of the 15 worldwide crane species, begin their 5000-7000 mile migration to the subarctic in North America and Siberia. Their final staging area is on the Platte River. They go to the Platte because there is food nearby–formerly small animals but now mostly corn–and because of the safety that one of the largest braided rivers in North America offers. They feed in the adjacent fields by day and roost in the river by night, where the shallow water allows them to hear predators approach. Before the Platte was dammed and water used for irrigation, recreation and drinking, it was a mile wide and an inch deep, too thick to drink, too thin to plow.

Now, the Platte in many areas contains less water and has invasive species and many trees growing nearby, limiting the habitat to 50 usable miles from the formerly 200. Rowe Sanctuary owns 4 miles of river and 1900 adjacent acres, which has been preserved as habitat. Every night in March, up to 600,000 Sandhill cranes, 90% of the world’s population, roost in the river. And every morning, they leave. It is a spectacle that Jane Goodall has called one of the world’s best. I’ve been fortunate to have seen many great sights in nature. This one is in my top three, seeing a solar eclipse and a wolf in the wild being the other two. I love seeing it so much that I volunteer at the Sanctuary, along with dozens of others, helping the full time staff of four–that’s right, four–show visitors the cranes from viewing blinds, for cranes are hunted in every one of the 17 states they pass through except Nebraska.

Many talk about the cranes that migrate to Arizona. I just say, “You don’t understand.” And you can’t, until you witness the occasional flocks of fifty thousand cranes, darkening the sky.

Stevie Staples mentored one of the Rowe Staff and lived 74 years, dying in 2006 from cancer. She was a former canoe racer and a real character. I once raced canoes, and I would have loved to have discussed racing with her. She touched the people at Rowe. She knew that, for she did live to see a beautiful picture of a Sandhill Crane in flight with her volunteer tag with “9 years of service” on it, because a picture of her receiving the picture is on a desk of the person she mentored.

Jamalee Fenimore grew up in Nebraska and practiced veterinary surgery in Washington state. She died of cancer far too young at 49, donating her estate to Rowe. Nobody at Rowe knew or remembered her being there. But obviously, she was touched by the river, the cranes and the sanctuary. We volunteers learn that we may touch visitors in ways we never know.

When I volunteer at Rowe, I work 17 hour days, sleeping on the floor in the sanctuary so I can hear the cranes on the river in the middle of the night. I guide people to the viewing blinds, I clean toilets, paint, greet people, and now am setting up “Nature by the Numbers,” where we hope to show teachers and students how math and science are used in the real world, so we don’t lose our connection to nature. The escaped, illiterate slaves used the North Star on the Underground Railroad. How many of you readers can find the North Star? How many of you have slept under the stars, how many bird species or constellations can you identify? What is the Moon’s phase tonight? How many large mammals, excluding deer, have you seen?

On my last tour, I took a disabled person to Stevie’s blind in an electric golf cart. Had he been able to walk, all of the group would have gone to Strawbale blind, which was the plan. But we still saw many cranes, American white pelicans, and unusual behavior. My rider loved the view and tried to tip me, which I of course refused, asking him to put the money in the container at the sanctuary. I planned to talk to other clients, because as the lead guide, I hadn’t spent time with them. But I spent time with this man. He was originally from Singapore; when I told him I had been there twice, his first comment was “Thank you for saving my country.” I’ve never heard that before, and it did me good. I hope I and Rowe did him good.

We touch each other in ways we may never know. Good people spread kindness throughout their world. The lucky ones receive that kindness or are those who live long enough to discover that their kindness was deeply appreciated and honored. But all who spread kindness are fortunate that they have the ability to do so. Stevie knew in her final days that her kindness was appreciated. I hope Jamalee Fenimore did, too. But if not, I know she knew she was doing the right thing. I deeply appreciate what she did. And every time I guide people to either of the two blinds, I tell them the story. Both women deserve to be remembered. And to have a viewing blind named for you on a river where a half million cranes visit every March is a wonderful honor. It also reminds me of my duty.